不同年龄原发性肝癌患者TACE术后自我管理效能感的相关影响因素分析及护理对策

Factors affecting the self-care efficacy and nursing measures of patients with primary hepatic carcinoma in different ages after TACE

目的探讨不同年龄原发性肝癌（primary hepatic carcinoma,PHC）患者肝动脉化疗栓塞术（transcatheter arterial chemoembolization,TACE）术后自我管理效能感的影响因素及护理对策。方法选取2013年1月至2014年9月四川大学华西医院上锦分院收治的282例行TACE的原发性肝癌患者为研究对象,根据年龄层次分为青年组（≤45岁,80例）、中年组（45~59岁,120例）和老年组（≥60岁,82例）,比较各年龄组原发性肝癌患者TACE术后自我管理效能感水平及构成比,同时采用问卷调查对可能影响各组患者自我管理效能感的因素进行统计分析。采用生活质量量表、社会支持量表、记忆症状评估量表等对各组患者术后生理、心理、社会方面进行评价,并分析和自我管理效能感的相关性。结果各年龄组原发性肝癌患者TACE术后自我管理效能感均处于较低水平,组间量化值与构成比均无统计学差异。影响青年组术后自我管理效能感的因素包括婚姻状况、经济收入情况、病程长短、健康培训状况、介入治疗次数以及甲胎蛋白水平等;影响中年组术后自我管理效能感的因素包括家庭类型和甲胎蛋白值等;影响老年组术后自我管理效能感的因素包括文化程度和ECOG体能评分。各年龄组患者TACE术后自我管理效能感均与心理功能、症状不良反应呈正相关,与心理症状呈负相关。青年组还与社会功能呈正相关,中老年组还与躯体功能、生理症状相关。结论不同年龄原发性肝癌患者TACE术后自我管理效能感水平均较低,且影响因素不同,护理时应重视各组患者的自我管理效能感的影响因素,进行个性化护理。

Objective To investigate the factors affecting the self-care efficacy of primary hepatic carcinoma （PHC） patients in different ages after TACE and to explore the appropriate nursing measures. Methods Total of 282 patients with PHC in West China Hospital of Sichuan University from January 2013 to September 2013 were selected and divided into three groups based on the age： the young group （≤45 years old, n = 80）, the middle age group （45~60 years old, n = 120） and the elderly group （≥ 60 years old, n = 82）. The levels and constituent ratio of self-care efficacy of the three groups were compared. Questionnaires were used to analyze the factors that might affect the self-care efficacy of PHC patients after TACE. Health Promotion Strategy Scale, Social Support Scale and Memorial Symptom Assessment Scales were used to evaluate the correlation of the self-care efficacy and the physical, psychological and social factors. Results The self-care efficacy was low in all groups and no statistical differences were shown （P 〉 0.05）. Factors affected the self-care efficacy of the young group included marital status, income situation, duration of disease, health training status, number of interventional treatments and level of serum AFP. Factors affected the middle age group included family type and level of serum AFP. Education situation and ECOG score affected the elderly group. The self-care efficacy of all groups had positive correlation with mental function and symptoms of adverse reactions and negative correlation with psychological symptoms. The young group were also correlated with social function, while other groups with physical function and symptoms. Conclusion Different factors induce low level of self-care efficacy in different groups based on age, and the personalized care was necessary.